This is a call I am familiar with and it has brought up some discussion. Curious to hear other opinions.
Called for full arrest for 84 YOF.
Hx:
DM2, A-fib, lung cancer, chronic pain. Last seen normal last night.
Meds:
Coumadin, levothyroxine, fentanyl patch, unknown others (family doesn't have a list)
Family couldn't wake her around 10am. Pressed life alert button. Life alert asks if PT is breathing, family says no, life alert instructs to start compressions.
You arrive to find PT laying in recliner with family doing ineffective compressions. Skin is pale but not ashen, warm centrally, cool in extremities. No carotid felt on initial attempt. Pt moved to floor, compressions continued. After about five compressions spontaneous breathing noted, compressions stopped, carotid pulse is weak and irregular.
Partner now has monitor patches on showing a-fib. PT is breathing spontaneously around 6/min. Ventilations assisted by BVM while fire helps package, secure, and move pt to ambulance.
Vitals:
PT unresponsive to pain
139/51
BGL 133
HR 100-130 A-Fib
SPO02 up to 96% with BVM. Good compliance with NPA placed.
Transport initiated, IV established, 12 lead unremarkable, ETCO2 is easily managed around 40 with BVM. PT remains stable but unresponsive in transport. Spontaneous respirations improve to around 16 with BVM assistance, fall back to around 8 if BVM is withheld. Carotid pulse is now strong and irregular. Crew unable to find fentanyl patch. 2mg Narcan pushed, no changes.
Fire is driving. You have two medics in the back. Airway remains patent with good compliance on BVM ventilations. Intubation would require RSI protocol.
Unknown if PT ever fully arrested, general agreement is probably not. Transport to Level 1 is approx 15 min. Do you intubate enroute? Why or why not?
Called for full arrest for 84 YOF.
Hx:
DM2, A-fib, lung cancer, chronic pain. Last seen normal last night.
Meds:
Coumadin, levothyroxine, fentanyl patch, unknown others (family doesn't have a list)
Family couldn't wake her around 10am. Pressed life alert button. Life alert asks if PT is breathing, family says no, life alert instructs to start compressions.
You arrive to find PT laying in recliner with family doing ineffective compressions. Skin is pale but not ashen, warm centrally, cool in extremities. No carotid felt on initial attempt. Pt moved to floor, compressions continued. After about five compressions spontaneous breathing noted, compressions stopped, carotid pulse is weak and irregular.
Partner now has monitor patches on showing a-fib. PT is breathing spontaneously around 6/min. Ventilations assisted by BVM while fire helps package, secure, and move pt to ambulance.
Vitals:
PT unresponsive to pain
139/51
BGL 133
HR 100-130 A-Fib
SPO02 up to 96% with BVM. Good compliance with NPA placed.
Transport initiated, IV established, 12 lead unremarkable, ETCO2 is easily managed around 40 with BVM. PT remains stable but unresponsive in transport. Spontaneous respirations improve to around 16 with BVM assistance, fall back to around 8 if BVM is withheld. Carotid pulse is now strong and irregular. Crew unable to find fentanyl patch. 2mg Narcan pushed, no changes.
Fire is driving. You have two medics in the back. Airway remains patent with good compliance on BVM ventilations. Intubation would require RSI protocol.
Unknown if PT ever fully arrested, general agreement is probably not. Transport to Level 1 is approx 15 min. Do you intubate enroute? Why or why not?